K- ____

PERFORMANCE CHECKLIST S- ____

Pediatric FBAO Management
A- ____

Name: _________________________________________ Date: _______ Rating: _______

Instruction: Rate the student properly after the student practiced the procedure and ready to perform the
return demonstration.
Legend: 4- Action is correct, complete and performed in proper order and timing.
3- Action is correct, complete but not in order and performed action slowly or very fast.
2- Action is incorrect and incomplete and performs action very slowly or very fast.
1- Action is not performed but mentioned.
0- Did not perform and did not mention the step in the procedure.

Performance Criteria 4 3 2 1 0 CI’s Remarks

Knowledge (30%)
Separate test was given for this part
SKILLS (35%)
FBAO MANAGEMENT IN RESPONSIVE INFANT (< 1 year old):
1. Scene size up (Check for safety).
2. Observe Body Substance Isolation Precaution (Don PPE).
3. Introduce self and secure for consent.
4. Assess for the severity of obstruction.
a. For mild (partial) airway obstruction: encourage the child to cough.
b. For severe airway obstruction in infants (< 1 year old) perform the
following steps:
5. Call for help / Activate Emergency System (EMS)
6. Position self properly (seating or kneeling) and hold the infant prone with the
head slightly lower than the chest, resting on your forearm.
7. Support the infant’s head by firmly supporting the jaw. Rest your forearm on
your thigh to support the infant.
8. Using the heel of one hand, deliver up to 5 sharp back blows in the middle of
the back between the infant’s shoulder blades.
9. If back blows fail to dislodge the object and the infant is still conscious,
deliver up to 5 Chest Thrusts.
10. Support the occiput of the infant’s head with the palm of your hand and turn
the infant as a unit while carefully supporting the head and neck.
11. Hold the infant in the supine position, with your forearm resting on your
thigh. Keep the infant’s head lower than the trunk.
12. Locate the ‘landmark’ for chest thrusts: lower third of the sternum,
approximately 1 finger breadth below the intermammary line
13. Provide up to 5 quick downward chest thrusts. Following each chest thrust,
check to see whether the obstruction has been dislodged.
14. If the airway remains obstructed, continue alternating up to 5 back blows
with up to 5 chest thrusts. until the object is removed or the victim becomes
unresponsive.
FBAO MANAGEMENT IN UNRESPONSIVE INFANT (< 1 year old)
If the infant victim becomes unresponsive, perform the following steps:
1. Support and position the infant in supine in flat, firm surface.
2. Call for help / Activate Emergency System (EMS) if it is still unavailable. Do
not leave the child alone
3. Initiate CPR. Locate the landmark and perform 30 chest compressions using
the same location and techniques used in CPR.
4. Perform the Head-Tilt and Chin-Lift maneuver to open the airway. Open the
mouth gently to check for visible foreign bodies.
5. If an object is visible, attempt to remove it with a finger sweep. Do not
perform a blind finger sweep.
6. Open the airway with a head tilt–chin lift and attempt 2 ventilations or
rescue breaths (RB). Cover the infant’s nose and mouth with your mouth.
7. Determine the effectiveness of each ventilation. If the chest fails to rise,
reposition the head and attempt another (2nd) RB.
8. If the infant/child remains unresponsive, perform again CPR or 30 chest
compressions
9. Before repeating ventilations, check the mouth for the presence of an object
and remove it with a finger sweep.
10. Continue CPR and RB as needed. If breaths are effective, check for signs of
circulation.
11. If the infant demonstrates adequate breathing and signs of circulation, place
the infant in a recovery position.
FBAO MANAGEMENT IN RESPONSIVE CHILD (> 1 year old):
1. Scene size up (Check for safety)
2. Observe Body Substance Isolation Precaution (Don PPE).
3. Introduce self and secure for consent.
4. Assess for the severity of obstruction. Ask the child: “Are you choking?”
a. For mild airway obstruction: encourage the child to cough.
b. For severe airway obstruction in CHILD (> 1 year old) perform the following
steps:
5. Call for help / Activate Emergency System (EMS)
6. Stand or kneel behind the child.
7. Put your arms around the child’s abdomen. Locate the navel. Place 2 fingers
above the navel and well below the tip of the xiphoid process.
8. Make a fist with the other hand with the thumb in the palm. • Place the
thumb side of the fist against the child’s abdomen, midline and above the 2
fingers’ spacing
9. Place the flat, thumb side of 1 fist against the victim’s abdomen in the midline
slightly above the navel and well below the tip of the xiphoid process.
12. Grasp the fist with the other hand and exert a series of up to 5 quick inward
and upward thrusts into the child’s abdomen. Do not apply force on the
xiphoid process.
13. Continue the series of up to 5 thrusts until the foreign body is expelled or the
victim becomes unresponsive.
FBAO MANAGEMENT IN UNRESPONSIVE / UNCONSCIOUS CHILD (> 1 year old)
1. Position the child. Support and position the child in supine on a firm, flat
surface.
2. Call for help / Activate Emergency System (EMS). Do not leave the child
alone.
3. Initiate CPR. Locate the landmark and perform 30 chest compressions using
the same location and techniques used in CPR.
4. Perform the Head-Tilt and Chin-Lift maneuver to open the airway. Open the
mouth gently to check for visible foreign bodies
5. If an object is visible, attempt to remove it with a finger sweep. Do not
perform a blind finger sweep.
6. Open the airway with a head tilt–chin lift and attempt 2 ventilations or
rescue breaths (RB). Provide mouth to mouth ventilation.
7. Determine the effectiveness of each ventilation. If the chest fails to rise,
reposition the head and attempt another (2nd) RB.
8. If the child remains unresponsive, perform again CPR or 30 chest
compressions.
9. Before repeating ventilations, check the mouth for the presence of an object
and remove it with a finger sweep.
10. Continue CPR and RB as needed. If breaths are effective, check for signs of
circulation.
11. If the child demonstrates adequate breathing and signs of circulation, place
in a recovery position.
ATTITUDE (35%)
1. Reports to Return Demo area on time.
2. Greets the CI and introduces self.
3. Presents self for return demonstration with proper grooming-prescribed
haircut/fixed hair, short, unpolished nails and wearing complete school
uniform/Type B shirt
4. Has initiative in preparing materials for the procedure, resourceful with
available materials and manages time effectively.
5. Accepts and listens to suggestions and criticisms graciously, showing effort
to overcome shortcomings and liabilities.
6. Makes use of rational and sound judgment.
7. Communicates concerns politely and tactfully to CI.
8. Displays professionalism and self-confidence.
9. Has initiative, resourceful and uses time creatively

Student’sRemarks:__________________________________________________________________________
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_____________________________________ __________________________________
Student’s Signature Printed Name &Signature of CI